On Purpose with Jay Shetty

WORLD’S TOP OBGYN Dr. Aliabadi: The #1 Hormone Problem Affecting Millions of Women (And The 4 Changes That Can Reverse It)

March 11, 2026

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  • PCOS affects 15% of women and is often missed because diagnosis requires meeting only two out of three criteria: ovulation dysfunction, PCOS-looking ovaries on ultrasound/high AMH, or elevated androgens/symptoms. 
  • PCOS is a total body issue driven by four pillars—insulin resistance (the first domino), hormones (androgens), chronic inflammation, and neurology—and requires addressing all four for true healing. 
  • Painful periods, severe pain, painful sex, chronic bloating, and bladder/bowel symptoms are signs of endometriosis, which affects 10-20% of women and is often misdiagnosed as psychological. 
  • Treating underlying conditions like endometriosis is crucial for resolving secondary issues such as leaky gut, bloating, and fatigue, as simply treating the symptoms is insufficient. 
  • Physicians must adopt a holistic approach, as specialists often treat conditions in silos (e.g., a GI doctor ignoring endometriosis as a cause of leaky gut), leading to incomplete patient care. 
  • Infertility is often mislabeled as 'unexplained' because common underlying conditions like endometriosis, PCOS, and autoimmune disorders are frequently missed or dismissed by standard medical evaluations. 

Segments

PCOS Undiagnosed Crisis
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(00:01:45)
  • Key Takeaway: 75% of women with PCOS and over 90% with endometriosis remain undiagnosed, contributing significantly to unexplained infertility.
  • Summary: Dr. A highlights the silent crisis of undiagnosed PCOS and endometriosis, noting these conditions are the leading cause of infertility globally. She emphasizes that many women struggle without answers because their symptoms are dismissed by healthcare providers. This lack of diagnosis prevents women from addressing the underlying physiological issues causing their distress.
Defining PCOS Criteria
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(00:06:10)
  • Key Takeaway: PCOS diagnosis requires meeting two out of three criteria: ovulation dysfunction (irregular periods), PCOS-looking ovaries on ultrasound/high AMH, or elevated androgens/symptoms.
  • Summary: PCOS is defined as a chronic hormonal, metabolic, inflammatory, and neurological condition affecting 15% of women. Symptoms like anxiety, depression, weight gain, and eating disorders are physiological signals of this underlying condition. Patients can self-diagnose by meeting two of the three established criteria.
PCOS Pillar 1: Insulin Resistance
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(00:11:35)
  • Key Takeaway: Insulin resistance is the first domino in PCOS, causing cells to resist glucose uptake, leading to fat storage around organs and increased androgen secretion by the ovaries.
  • Summary: To address insulin resistance, patients should decrease carbohydrate intake and walk 10-20 minutes after every meal to activate insulin receptors. Supplements like the OV product can help pull sugar into cells, and prescription medications like Metformin or GLP-1s increase insulin sensitivity.
PCOS Pillars 2 & 3: Hormones and Inflammation
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(00:27:27)
  • Key Takeaway: High androgens cause a vicious cycle by stimulating rapid GNRH secretion, leading to chronically high LH, which further stimulates androgen release, blocking ovulation.
  • Summary: The second pillar involves high androgens disrupting the normal FSH/LH balance, causing chronic LH stimulation that blocks ovulation and exacerbates androgen symptoms. The third pillar is chronic inflammation, fueled by visceral fat, stress (cortisol), poor sleep, and gut issues, which worsens insulin resistance and androgen secretion.
PCOS Pillar 4: Neurological Impact
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(00:30:48)
  • Key Takeaway: Unstable estrogen, low progesterone, high androgens, and inflammation cause serotonin levels to drop and the amygdala (fear center) to become hyperactive, leading to anxiety, depression, and brain fog.
  • Summary: Normal estrogen and progesterone calm the limbic system; however, in PCOS, their instability causes decreased serotonin and dopamine, resulting in anxiety, irritability, and fatigue. These neurological effects, combined with inflammation, drive food cravings and eating disorders, often leading to misdiagnosis as purely psychological issues.
Endometriosis: Pain is Not Normal
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(00:40:15)
  • Key Takeaway: Severely painful periods that disrupt life, painful sex, chronic bloating, and recurrent bladder symptoms are signs of endometriosis until proven otherwise.
  • Summary: Endometriosis is a chronic inflammatory condition where uterine-like tissue grows outside the uterus, bleeding monthly and causing inflammation, pain, and scar tissue. The pain sensitizes the central nervous system over time, leading to anxiety and depression if the underlying pathology is ignored for the average 9-11 year diagnostic delay.
Endometriosis Treatment and Fertility Risk
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(00:46:07)
  • Key Takeaway: The most devastating cost of ignoring endometriosis is fertility loss, as chronic inflammation destroys egg count and quality, necessitating early diagnosis and hormonal suppression.
  • Summary: Endometriosis is a clinical diagnosis, not solely requiring surgery, and hormonal suppression (like progesterone IUDs or birth control) is the primary treatment to calm implants and preserve ovarian reserve. Patients with advanced disease or those who have been on birth control for over seven years should check their AMH (egg count) to monitor ovarian reserve.
Endometriosis and Gut Health
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(01:06:04)
  • Key Takeaway: Approximately 90% of endometriosis patients suffer from leaky gut or SIBO, which drives systemic inflammation, and this gut issue cannot be resolved until the underlying endometriosis is treated.
  • Summary: Leaky gut allows harmful substances to be absorbed, increasing inflammation, which exacerbates PCOS symptoms, bloating, and fatigue in endometriosis patients. Treating the endometriosis pathology first is crucial; only after suppression should SIBO be addressed, as persistent pain after treatment may indicate a need for neuromodulators to rewire the sensitized nervous system.
Endometriosis, Inflammation, and Gut Health
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(01:06:36)
  • Key Takeaway: Untreated endometriosis perpetuates inflammation and leaky gut symptoms like bloating and fatigue, requiring surgical intervention before addressing secondary gut issues like SIBO.
  • Summary: When inflammation increases, it creates a vicious cycle leading to brain fog, insulin resistance, and weight gain. If endometriosis is the underlying cause of leaky gut, treating the gut alone will not resolve the chronic symptoms. After surgery and IUD suppression, persistent bloating indicates the need to treat secondary issues like SIBO.
Rewiring the Brain Post-Pain
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(01:08:16)
  • Key Takeaway: Chronic pain can rewire the nervous system, necessitating neuromodulators like Affexor or Lyrica to calm the system even after pathology is addressed.
  • Summary: For patients with advanced disease and central sensitization from years of pain, pain, anxiety, and depression may persist post-operation. Neuromodulators can help rewire the brain and calm the nervous system after the primary pathology has been treated. This addresses the neurological impact of prolonged suffering.
Holistic Screening and Autoimmune Links
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(01:09:21)
  • Key Takeaway: Gynecologists must screen metabolically and for mental health, recognizing that endometriosis is autoimmune and increases the risk of other autoimmune conditions.
  • Summary: Every doctor should treat patients holistically; for example, GI doctors must consider endometriosis as a cause of leaky gut. If a patient has one autoimmune condition like endometriosis, there is a 30% chance of having another, requiring proactive screening for conditions like lupus or antiphospholipid syndrome.
IVF, Estrogen, and Autoimmunity
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(01:11:26)
  • Key Takeaway: IVF treatments that blast patients with estrogen can stimulate undiagnosed endometriosis, and the resulting flare-up may reveal a previously hidden autoimmune disorder.
  • Summary: IVF stimulation with high estrogen levels can exacerbate endometriosis pain in affected patients. The IVF process itself does not cause the autoimmune disorder, but it can push the condition forward, making it apparent. Diagnosing endometriosis correctly allows practitioners to proactively screen for other associated autoimmune disorders.
Fertility Planning for Mid-30s Women
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(01:12:50)
  • Key Takeaway: Women in their mid-to-late 30s seeking conception must prioritize ruling out endometriosis and PCOS, followed by comprehensive pelvic ultrasound and full hormone panels.
  • Summary: A thorough initial visit requires ruling out endometriosis and PCOS, as they are leading causes of infertility, and performing a pelvic ultrasound to check ovarian and uterine anatomy (fibroids, polyps, septum). Hormone checks must include thyroid, prolactin, testosterone, DHEAS (for adrenal PCOS), and AMH to assess egg count.
Conception Timeline and Stress Reduction
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(01:15:56)
  • Key Takeaway: Women 35 and older should try to conceive for six months before follow-up, avoiding constant ovulation tracking to minimize stress-induced hormonal imbalance.
  • Summary: Patients should start prenatal vitamins three months prior and address underlying PCOS/inflammation before trying to conceive. For those over 35, a six-month trial period is recommended, and partners’ health should also be screened via semen analysis early on. Avoiding obsessive tracking of ovulation prevents cortisol release that can disrupt hormonal balance.
Mandatory Pelvic Ultrasound Advocacy
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(01:17:38)
  • Key Takeaway: Pelvic ultrasounds should be mandatory during Well Woman exams because bimanual exams alone cannot screen for conditions like fibroids, polyps, or septums that impact health and fertility.
  • Summary: The speaker advocates for making pelvic ultrasounds a mandatory part of annual Well Woman exams. These imaging procedures reveal critical structural issues that are otherwise completely missed by standard physical exams. Without ultrasound, women are effectively being denied necessary diagnostic tools.
Six Buckets of Infertility Investigation
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(01:22:05)
  • Key Takeaway: Unexplained infertility is often resolved by systematically investigating six key areas: female hormones/egg count, male factor, anatomy, endometriosis, PCOS, and autoimmune disorders.
  • Summary: After one year of trying, investigate female factors (hormones, AMH), male factor (semen analysis), and anatomy (ultrasound for fibroids/polyps/septum, HSG for tube blockage). Endometriosis and PCOS must be investigated based on symptoms, and autoimmune screening is vital, especially for recurrent miscarriage risk due to conditions like antiphospholipid syndrome.
The Trauma of Dismissed Women’s Health
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(01:28:17)
  • Key Takeaway: The systemic dismissal of symptoms related to PCOS, endometriosis, and mental health leads to delayed diagnosis, often resulting in the loss of fertility and increased psychological trauma.
  • Summary: The speaker details the tragic trajectory of women whose symptoms (weight gain, anxiety, pain) are blamed on lifestyle rather than physiological causes like PCOS. This gaslighting results in years of misdirected treatment, often leading to the depletion of egg reserve by the time they seek specialized care. Changing this healthcare system is presented as the speaker’s calling.